A biased look at psychology in the world

Chronic Pain

March 23, 2016

One good thing about music, when it hits you, you feel no pain. Bob Marley

There is no disputing that the need for effective pain relief has never been greater. While we all experience pain once in a while, chronic pain (usually defined as pain lasting longer than three to six months) can be devastating for many pain sufferers. With an estimated ten to 55 percent of people worldwide developing chronic pain worldwide, it's hardly surprising that pain relievers, particularly medications containing form of opium, are in constant demand in countries around the world. Along with obtaining these drugs legally through a doctor's prescription, there are also street drugs that can also be used for relieving pain, including heroin and opium. Though there are alternative methods for pain management that avoid the potential addiction issues surrounding opiates, research studies looking into their actual effectiveness often yield contradictory results..

As an alternative to medication, non-chemical pain management techniques such as relaxation training or guided imagery can also help control pain using the principle of distraction. By using different mental activities to occupy the minds of pain patients, their awareness of pain is reduced which provides basic relief. While using relaxation training or interactive media such as video games or virtual reality can help provide the distraction pain patients need, they often aren't cost-effective compared to less expensive options such as medication. Whether due to the expense of providing trained staff to teach relaxation techniques or the cost of specialized equipment, many physicians find it easier and cheaper to prescribe pain medication. Even when pain management programs are available, the demand for treatment can mean long waiting lists and needless suffering.

But what about simpler alternatives such as listening to music? Research looking at the link between music listening and pain tolerance suggests that it is not only effective in relieving acute and chronic pain but can also help patients manage anxiety and depression. According to one study from 2012, two daily sessions of music listening helped a sample of chronic pain patients relieve symptoms related to conditions such fibromyalgia, inflammatory disease, or neurogenic pain as well as the anxiety and depression linked to chronic pain.

November 05, 2015

A recent review published in Progress in Neuro-Psychopharmacology & Biological Psychiatry discusses nature of Cannabis and cannabinoids. The duality arises from the potential and actuality of cannabinoids in the laboratory and clinic and the ‘abuse’ of Cannabis outside the clinic. The therapeutic areas currently best associated with exploitation of Cannabis-related medicines include pain, epilepsy, feeding disorders, multiple sclerosis and glaucoma. As with every other medicinal drug of course, the ‘trick’ will be to maximise the benefit and minimise the cost. After millennia of proximity and exploitation of the Cannabis plant, we are still playing catch up with an understanding of its potential influence for medicinal benefit.

September 29, 2015

Since first opening in June, the Marijuana for Trauma centre in Sydney, Nova Scotia has allowed trauma sufferers to access medical marijuana that would otherwise be denied them. Originally established to help veterans dealing with the symptoms of posttraumatic disorder, centre staff report that the list of patients now includes non-veterans as well.

"We have cancer patients that are coming through, people that are in constant pain," said volunteer Joe MacGillivray. "People that just had surgeries." He added that patients looking for an alternative to heavy pain medication are finding that marijuana is much more effective, both for relieving pain and avoiding the mental confusion that often comes with drugs such as Oxycontin and Dilaudid. In an interview with CBC news, MacGillivray reveals that he is a veteran and a PTSD sufferer himself and found that marijuana helped relieve many of his most upsetting symptoms. "Before, I tried suicide twice," he said. "I still have my days like everybody else, but it doesn't hit as hard and it's a little more easy to deal with."

At the centre, volunteers like Joe MacGillivray and centre president, Vince Rigby, help patients deal with medical providers licensed to provide medical marijuana. This includes helping with the proper dosage,, learning about the best marijuana strains, and dealing with the legal barriers that can often deter people in need. There are presently eighty patients being helped through the centre but at least another thirty are still on the waiting list. According to Rigby, many family doctors are extremely reluctant to prescribe medical marijuana to their patients due to the stigma associated with it. Even when prescriptions are given, doctors often fail to provide instructions on how marijuana can be used most effectively. That's when places like the Marijuana for Trauma Centre are most needed.

Despite the availability of places such as the Marijuana for Trauma centre, many chronic pain and trauma patients in Canada still find themselves in a legal quandary regarding medical marijuana. People living far from large cities often need to travel long distances to get access and can even face arrest if they fail to prove that the marijuana in their possession was legally obtained. The Federal government under the current administration has long opposed decriminalization of marijuana and even using it for medical purposes remains controversial for many politicians.

May 19, 2015

For the transgender man identified only as "Jorge", the ordeal began when his girlfriend's mother caught him them together in her home in Ecuador. Shortly afterward, the girlfriend was forcefully abducted and placed in a private rehabilitation hospital offering "behaviour therapy" aimed at changing sexual interest. Several months later, Jorge's parents made arrangements for Jorge to be forcibly placed there as well. In his case, his parents wanted him to give up identifying himself as a man and return to being a traditional Ecuadoran female. Loosely based on the "Twelve-steps" model endorsed by Alcoholics Anonymous, Jorge was kept a prisoner in the clinic and denied any contact with his girlfriend or outside agencies that could help him. He was also forced to dress in enticing female clothing, to read Bible passages each day, and also to endure physical beatings. He was only able to win his release after seven months of this kind of abuse.

Though most of these private hospital focus on treating drug and alcohol addiction, some have quietly begun offering behaviour modification programs aimed at "behaviour disorders", a convenient label that is often extended to homosexuality and transgender cases in a society that still has difficulty accepting sexual minorities. While forced-conversion treatment is illegal under Ecuadoran law, getting police to investigate and lay charges is often difficult. With more than two hundred of these centres, most of which are poorly monitored, investigating every complaint can be expensive, especially in a country that has gutted much of its public health spending.

Over the past fifteen years, the number of addiction clinics has soared and can now be found in every part of the country, often with little real oversight. This has allowed many of these addiction centres to quietly expand their mandate to include what local activists refer to as "dehomosexualization". Since many families, and the clinics themselves, regard homosexuality as an addiction, forcing their gay and lesbian children into these clinics for treatment, even though illegal, seems their only hope for a "cure." Much like the treatment of addiction, these clinics tell their homosexual clients that they will be forcibly held "til you change." Whatever the tactics used, they all focus on "garroterapia" (therapy by the stick), something that has earned them the nickname of "Nazi clinics."

Since few, if any of these centres, operate with qualified professionals, former patients seeking to lay a complaint have few real options. Most of the clinics are run by former substance abusers who graduated from treatment themselves and started their own clinics as a way of making a living. By diversifying the services they offer, including the "treatment" of homosexuality, these clinics hope to make a lucrative living, and many become extremely successful.

While the Ecuadoran government has passed laws banning many of the most abusive practices, including the use of restraints, solitary confinement, beatings, and forced drugging, these practices still continue. Even clinics that have been shut down by the Ministry of Health multiple times are able to keep operating by closing and reopening their doors in the same facility or at a nearby location.

Still, these crackdowns only deal with the places supplying services that parents of gay children want. Educating the public that these kind of forced conversion programs don't work and that homosexuality is something that needs to be accepted rather than changed will likely take much longer.

As for Jorge and all the others caught in this terrible vise, the fear of being forced to undergo "dehomosexualization" remains very real.

May 07, 2015

In a study published in the journal Psychological Trauma, researchers examined sociodemographic, persecutor identity, torture, and postmigration variables associated with suicidal ideation in a clinical sample of 267 immigrant survivors of torture who have resettled in New York City. The purpose of this study was to identify variables associated with increased risk for suicidal ideation in survivors of torture before they receive legal, psychological, or medical services for torture-related needs. Results from a binary logistic regression model identified a combination of 3 variables associated with current suicidal ideation at intake into the program. Being female, having not submitted an application for asylum, and a history of rape or sexual assault were significantly associated with suicidal ideation at intake, when also controlling for several other important variables. The final model explained 21.4% of variation in reported suicidal ideation at intake. The discussion focused on the importance of conducting a thorough assessment of suicidal ideation in refugees and survivors of torture.

April 12, 2015

We will likely never know how much heroin Bayer actually produced or how much of a profit they made from this wonder drug of theirs. Some available data suggests that they were producing about a ton of heroin a year by 1899 and transporting it to twenty-three countries. Heroin was available in cough drops, tablets, in liquid form, etc. To be fair, Bayer never advertised heroin to the public but, then again, they didn’t need to. The advertisements aimed at physicians ensured that patients eventually got the word about this marvelous new product.

During the sixteen years that followed its release, heroin was available just about everywhere. Not only could it be bought over the counter at any corner pharmacy, it could be purchased by mail order as well. The Bayer brand name was something any drug purchaser could rely on and the concept of “drug addiction”, if it was considered at all, was largely confined to “hard drugs” such as opium.

But the honeymoon didn’t last long as far as heroin was concerned. While one doctor, A. Morel-Lavallee suggested in 1902 that heroin could be used to “demorphinize” morphine addicts, other doctors began reporting cases of heroin withdrawal in the medical literature. Despite efforts to present heroin as a “non-addictive” pain reliever, it quickly proved to be nothing of the kind. If anything, heroin addiction appeared even worse than with morphine.

Perhaps more than in any other country, the heroin epidemic hit the United States especially hard. Though other countries such as Canada, Great Britain, and Germany had federal laws to control dangerous pharmaceuticals, the U.S. Constitution placed medical regulation almost exclusively under state control. While many states had laws in place requiring heroin, cocaine, or morphine to be only available by prescription, bypassing the laws proved to be as simple as crossing state lines to get access to these same drugs with little hassle.

By the end of the first decade of the twentieth century, heroin’s addictive potential became all too apparent. In New York City, the first case of heroin addiction was admitted to Bellevue Hospital in 1910 and by 1915, there were more than four hundred. A 1912 news story I found reflected this growing mistrust. “Heroin, which is derived from morphine, is so frequently employed in the treatment of various diseases that the question of formation of habit from its use is a serious one.” The article goes on to warn that even physicians appear likely to underestimate the addiction risks of heroin and often prescribed it freely without monitoring whether patients were becoming addicted.

According to the Psychiatric Bulletin of the New York State Hospitals, most of these new addicts being seen in Bellevue were gang members who treated it as a recreational drug. The Tenderloin district of New York became a major hub of the underground heroin trade with “snuffing” (taking in heroin nasally by inhaling) becoming increasingly popular among drug addicts. Though medical doctors and anti-drug activists were warning that a new epidemic of heroin abuse was on the rise, police and prosecutors were still limited by what they could do about it.

By 1914, the crackdown on heroin and cocaine really began with the passing of the Harrison Narcotic Tax Act. Mainly focusing on opium and cocaine, the Act basically imposed taxes on the sale and import of opium and other narcotics. Despite being called a tax act, it was anything but since the lawmakers who drafted the legislation were basically hoping to end rampant drug abuse in the United States. With the end of World War I, international agreements were made part of the Treaty of Versailles and forced all participating nations to pass their own drug laws.

Despite the Act, doctors were still free to prescribe heroin and morphine to their patients. Unfortunately, the Act also banned doctors from prescribing narcotics for people who admitted being addicted. By 1919, all addicts were essentially transformed into criminals since they could no longer get their drugs legally. To deal with this new demand, a black market for drugs began to flourish, especially in Eastern cities such as New York drugs that were either stolen from legitimate companies or smuggled in from other countries were available. While the government tried cracking down on drug smuggling, dealing with legally available narcotic drugs was often a nightmare for everyone involved.

Doctor Alexander Lambert, professor of medicine at Cornell University and noted substance abuse expert warned in 1924 that heroin was a “vice of the underworld” and that most of the heroin addicts he saw were young men between the ages of seventeen and twenty-five. Not only was heroin easy to get but drug dealers made enormous profits by “cutting” their products with other chemicals that resembled heroin enough to fool customers into thinking that they were buying pure heroin (criminals weren’t obliged to follow the Pure Food and Drug Act).

It was during the early 1920s that many drug users supported their habit by collecting scrap metal from junkyards to sell for drug money (which is what earned them the name of “junkies”). There was also a sharp rise in violent crime due to the need for money to buy drugs though not enough to justify the hysteria about narcotics that was brewing at the time.

The fact that this was the same era that saw the passage of the Eighteenth Amendment and the rise of Prohibition is probably no coincidence. Alcohol had long been a target by organizations such as the Women’s Christian Temperance Union for its perceived role in corrupting impressionable young people and undermining public morality. As well, the rising animosity towards racial minorities that led to stricter immigration laws keeping out “undesirables” such as Chinese and East European refugees was often linked to fears of the “Yellow Peril” and the opium that transformed them into drug-crazed fiends. That many of those same gang members who used heroin often belonged to these despised minorities was hardly overlooked.

Along with newspaper stories describing alcoholics who ruined their lives and the lives of people around them, there were also stories about the dread Dope Fiends who stalked “normal” people and threatened society itself. The true king of yellow journalism was, of course, William Randolph Hearst, “Citizen Kane” himself. Long an advocate of using fear to sell papers, Hearst latched onto any new trend he could find. Whether it was denouncing the “Yellow Peril” (fear of orientals), the “Red Peril” (fear of communists), or “voodoo satanic music” (jazz), Hearst’s editorials were there to feed the terror of the American people.

During the 1920s and 1930s, Hearst’s editors relentlessly promoted the idea that Drugs = Violent Crime. Along with familiar narcotics such as opium and cocaine, heroin and cannabis were particularly singled out. Heroin, since it was regarded as just another form of opium, and cannabis due to its Hispanic associations. Even the name “marijuana” (Mexican slang for the plant) was promoted by Hearst as a way of slandering Mexicans. Usually just called cannabis or hemp, it says a lot about the power of Hearst’s editorials that just about everyone began calling it marijuana as a result of his influence.

With anti-drug rhetoric such as this dominating the debate over drugs such as heroin and morphine, it’s hardly surprising that the political climate was shifting towards more draconian laws. With the end of Prohibition in 1933, newspapers and conservative lawmakers needed a new cause and the anti-drug era truly began.

Remember Bayer? Though heroin would never be as profitable as they originally hoped, they continued to produce it until 1913. Heinrich Dreser terminated his association with Bayer a year later and moved to Dusseldorf to found his own pharmacological academy. Despite rumours that he was a heroin addict as well, he seemed to live his final years in comfort, courtesy of the fortune he had made from both heroin and aspirin. He died in 1924, the same year that the U.S. banned heroin completely.

Ironically, Dreser died of a stroke, something that might have been avoided if he had known to take an aspirin a day as patients at risk are advised to do nowadays. While aspirin continues to be sold worldwide with new applications being discovered each decade, Great Britain remains the only country in the world to allow heroin for treating chronic pain (95 percent of all medically prescribed heroin is sold there). But heroin’s popularity as a street drug remains greater than ever. With millions of heroin users worldwide and billions being spent on anti-drug policies, the miracle drug that Dreser and Bayer gave the world is still changing lives.

March 12, 2015

Youth under 25 show substantial sexual and substance use risk behaviors. One factor associated with risk behaviors is delay discounting, the devaluation of delayed outcomes. A study published in Experimental and Clinical Psychopharmacology determined if delay discounting for sexual outcomes is related to sexual risk and substance use among 18–24 year olds. Females (70) and males (56) completed the Sexual Discounting Task, which assessed their likelihood of having unprotected immediate sex versus waiting for sex with a condom, at various delays, with 4 hypothetical sexual partners selected from photographs: the person they most wanted to have sex with, least wanted to have sex with, judged most likely to have a sexually transmitted infection (STI), and judged least likely to have an STI. They also completed instruments assessing HIV knowledge, sexual behaviors, substance use, risk attitudes, inhibition, impulsivity, and sensation-seeking. Condom use likelihood generally decreased with increasing delay. Preference for immediate, unprotected sex was greater for partners whom participants most (vs. least) wanted to have sex with and judged least (vs. most) likely to have an STI. Preference for immediate, unprotected sex in the “most want to have sex with” and “least likely to have an STI” conditions was related to greater lifetime risky sexual partners, lifetime number of unique substances used, disregard of social approval/danger, disinhibition, and sensation/excitement-seeking. Males showed greater likelihood of unprotected sex than females when condom use was undelayed, but delay similarly affected condom use between sexes. Delay discounting should be considered in strategies to minimize youth risk behavior.

January 12, 2015

Pray that your loneliness may spur you into finding something to live for, great enough to die for. Dag Hammarskjold

The mental and physical burden of loneliness can be extreme, especially for older adults. Usually defined as the perception of being isolated from signficant others, whether friends or family, people feel lonely because of the gap between the kind of social relationships they would like to have and the ones they see themselves as having. Since nobody's life is ever truly perfect, we all feel lonely from time to time though the feeling is usually manageable and temporary.

Still, there are numerous studies showing the link between loneliness and the development of health problems, as well having a shorter lifespan. Along with depression and other psychological problems, chronic loneliness can also lead to sleep problems, hypertension, an impaired immune system, and the breakdown of the body's endocrine system.

The problems associated with loneliness often grow worse with time due to the natural health problems that come with age. As a result, loneliness is frequently a chronic problem in older adults due to increasing health problems which can make it harder for them to stay socially active. Age-related medical issues can also lead to greater psychological distress, including depression, and this can lead to people feeling even lonelier. Medical problems such as arthritis, cardiovascular disease, or cancer, can make many older adults feel more disabled and helpless.

July 15, 2014

While there is no question that opioid dependence is becoming a major problem, new research is also showing a rise in opioid-related deaths as well. Along with prescription drug abuse, opioids being sold as street drugs, and patients who doctor-shop to feed their drug habit, physicians have long warned that young and middle-aged patients are especially prone to premature death due to misuse of opioid painkillers. That includes morphine, codeine, oxycodone, hydrocordone, and an array of new painkillers that are coming on the market.

In North America, most opioid-related deaths occur in people 55 years of age or youger. Much of this can be linked to recreational use of drugs, especially in younger adults and adolescents, with one in seven high-school or university students reporting non-medical uses for opioids. The premature mortality reported in many jurisdictions may be costing more than $18 B in lost earnings in the United States alone.

Part of the problem with identifying the prevalence of opioid-related deaths is that many go unreported depending on the medical information available at the time of death. To gain a clearer picture of how many deaths can be linked to opioid use, a new research study recently published in the journal Addiction looked at opioid deaths over a ten-year period in the province of Ontario, Canada. Conducted by a team of researchers at the Institute for Clinical and Evaluative Sciences and the Sunnybrook Health Sciences Centre, the study examined coroner's reports for all deaths occurring between 1990 and 2010. Deaths were defined as opioid-related if toxicological screening after death showed opioid concentrations high enough to cause death or if a combination of drugs contributed to death. The researchers then calculated the annual rate of opioid-related deaths as well as demographic statistics. Based on age at the time of death, the researchers also calculated years of potential life lost (YLL) and broke down the deaths into different age groups (including adolescent, young adult, middle-aged adult, etc.).

Over the twenty-year period studied, there were 5,935 opioid-related deaths in Ontario. Of these, the median age was 42 years and 64.4 percent were men. Perhaps not surprisingly, over 90 percent of the opioid-related deaths involved people living in an urban neighbourhood. The researchers also found a 242 percent rise in deaths from 12.2 per million in 1991 (127 deaths annually) to 41.6 deaths per million in 2010 (550 deaths annually). With the exception of the youngest age group (0 to 14), the rise in opioid-related deaths occurred in all age groups. Of those age groups however, the highest increase was in people aged 25 to 34 years (rising from 3.3 percent in 1991 to 12.1 percent in 2010). There was also a sixfold increase for people aged 15 to 24 and 55 to 64 years. The annual rate of year of potential life lost also rose from 7006 years in 1992 to 21,927 years lost in 2010. The opioid-related deaths of people aged 25 to 54 accounted for almost 80 percent of years lost.

So what conclusions can be made from these findings? Not only have premature deaths due to opioids risen spectacularly over the past 20 years, but almost one in eight deaths occurring among people aged 24 to 35 years appear to involve an opioid. These figures do not take into account those deaths that were drug-related even though they were link to other causes. Even focusing on opioid-related deaths exclusively, the number of years lost due to premature mortality are staggering. Not did the years lost nearly double from 2001 to 2010, but they were greater than similar figures for alcohol and HIV/AIDS.

Though these results match other studies showing number of lives lost worldwide due to opioids, using coroner's reports allows for greater accuracy in determining cause of death. The researchers also suggest that focusing on opioid-related deaths may underestimate the impact of opioid addiction on society however. Since many opioid addicts will experience years of poor health before dying or may die of other causes, these study results may not reflect the full extent of health problems caused by opioid abuse.

Still, while opioid abuse appears linked to premature death, especially among young adults, there is no doubt that proper use of opioid-based painkillers can benefit countless people suffering from chronic pain. It is more important than ever that any opioid-based medication be carefully monitored by health professionals to avoid problems that could lead to misuse and premature death. These study results also highlight the deadly consequences of dangerous practices such as "doctor shopping" and using opioid-based street drugs. While many chronic pain patients may feel that they are not getting the pain relief they need, these medications should only be used as prescribed by physicians.

May 26, 2014

As we grow older, many of us need to learn how to live with chronic pain.

An estimated 60 to 75 percent of people over the age of 65 report having a problem with persistent pain and that rate is far higher for older people living in assisted care centres and nursing homes. In the United States alone, there are more than 40 million people over the age of 65 and that number is expected to rise in the coming years as Baby Boomers grow older. The majority of older Americans suffer from multiple conditions and the cost of treatment already accounts for more than two-thirds of the annual U.S. health budget.

The most common medical complains seen in older adults are osteoarthritis in the lower back and neck, musculoskeletal pain, chronic joint pain, and neuralgia linked to other conditions such as diabetes. Not only does pain become more prevalent as people grow older, but women are generally more likely to report persistent pain than men. While most older adults living with chronic pain tend to regard it as manageable for the most part, that can change as new medical conditions develop.

So how can we manage the pain problems that frequently arise as we grow older? A new review article published inAmerican Psychologist provides a comprehensive look at the numerous problems faced by older adults living persistent pain problems. Written by Ivan R. Molton and Alexandra L. Terrill of the University of Washington Medical Center, the article identifies many of the barriers faced by older adults dealing with chronic pain and gives some directions for providing better care.